CCFNC_Final_Capstone Summary Report.pdf

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Lara Balian

Adrienne Binder

Catherine Chao

Shannon Clancy

Sarah Mye

Asia-La’Rae Walker

In partnership with Cervical Cancer-Free North Carolina

Alexis Moore, MPH

Preceptor

Noel Brewer, PhD

Faculty Advisor

On our honor, we have neither given nor received any unauthorized aid on this assignment.

Improving North Carolina’s Capacity to Prevent

Cervical Cancer through Community Engagement,

a Needs Assessment, and Resource Strengthening

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II. ABSTRACT

Background: In 2013, Cervical Cancer-Free North Carolina (CCFNC) identified the South Central and Northeast regions of North Carolina (NC) as disproportionately affected by cervical cancer based on epidemiological surveillance data. Women diagnosed with cervical cancer in NC are often minorities, older, recent immigrants, and/or of lower income. Cervical cancer cases also tend to occur in women who have below average screening rates and HPV vaccination uptake. To address this disparity, CCFNC works with a coalition of partners that deliver and promote cervical cancer prevention services. In 2012, CCFNC

developed nine evidenced-based recommendations that could improve cervical cancer prevention.As the CCFNC Capstone team, we worked with stakeholders, who provide cervical cancer prevention services, to identify barriers and encourage the adoption of one of the recommended strategies to increase screening rates and HPV vaccination in high-need regions of NC.

Methods: We attended the North Carolina Cervical Cancer Coalition Summit (State Summit) to gather information about the prevailing cervical cancer challenges and stakeholder attitudes towards strategies for improving prevention. We summarized and shared highlights from the event with attendees and coalition members. We then identified and recruited key informants (n=32) from the South Central and Northeast regions of NC using the list of coalition partners and participant referrals. We conducted semi-structured key informant interviews (KIIs) with healthcare providers and educators involved in women’s health and

immunization to identify challenges and opportunities to improve cervical cancer prevention services in their respective regions. Qualitative data informed the content of the Cervical Cancer Prevention: Strengthening Health Systems and Programs in South Central North Carolina regional meeting. Key informants, coalition members, and other cervical cancer prevention stakeholders attended the regional meeting and participated in community action planning to outline strategies and action steps to implement prioritized recommendations. Following the meeting, our team summarized participant strategies and action steps in the community action plan report, which we distributed to attendees of the meetings. We also updated the NC Cervical Cancer Resource Directory and established a process that can be replicated in the future using our phone survey and web form. Lastly, our team developed an online survey in Qualtrics and analyzed responses to determine

recommendations for making the Resource Directory more useful to practitioners and promotional strategies to increase use of the Resource Directory.

Results: Participants at the State Summit prioritized two evidence-based recommendations to improve cervical cancer prevention. KIIs identified challenges and opportunities to providing cervical cancer

prevention services. They also informed the format and focus of the regional meeting and contributed to its success. At the regional meeting, participants outlined specific strategies and action steps to implement evidence-based recommendations deemed feasible for their organizations. Additionally, our Capstone team identified several barriers that limit use of the Resource Directory, including inaccurate entries, poor Spanish translation, and text with an advanced reading level. Based on these findings and results from the NC Cervical Cancer Resource Directory Survey, the team updated the directory, established a process for revising the directory in the future, and developed specific recommendations for improving utility and awareness of the tool among healthcare professionals.

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III. ACKNOWLEDGEMENTS

Our Capstone team graciously recognizes Alexis Moore, MPH, our wonderful preceptor who

selflessly stepped in to help guide us through our Capstone journey and consistently encouraged us to strive

for excellence. We thank our faculty advisor and Director of Cervical Cancer-Free North Carolina (CCFNC),

Noel Brewer, PhD, for his vision and guidance, as well as the passion he brings to addressing cervical cancer.

We also acknowledge Megan Hall, MPH, for providing insightful feedback, and the entire CCFNC staff for

supporting our Capstone efforts. We thank Kristina Felder, Research Assistant at CCFNC, for her valuable

contribution to our projects. Special thanks goes out to the Capstone Teaching Team, Meg Landfried, MPH,

Christine Brune, MPH, and Melissa Cox, MPH, for teaching us lifelong professional skills and for being a

consistent source of support, guidance, and feedback.

We extend a huge thank you to Suzanne Lea, PhD, Alice Richman, PhD, John Compagna, MD, and

Dianah Bradshaw, PhD, for their instrumental roles in the Cervical Cancer Prevention: Strengthening Health Systems

and Programs in South Central North Carolina regional meeting. We sincerely acknowledge all the clinicians, educators, stakeholders, community partners, and leaders across NC working to reduce the burden of cervical

cancer and eliminate the dramatic disparities that exist. We extend special warmth of gratitude to all South

Central and Northeast key informants for graciously sharing their time, insights, and wisdom in helping us

fulfill the goals of our Capstone project. We also thank Schatzi McCarthy, MAPA, for encouraging us to get

involved with cervical cancer initiatives and attracting us to this Capstone project.

All of your help made our Capstone project a fulfilling part of our lives. From the bottom of our

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IV. ACRONYMS & PUBLIC HEALTH TERMS

Table 1: Acronyms and Public Health Terms

Abbreviation _Definition

BCCCP Breast and Cervical Cancer Control Program

CAP Community Action Plan

CCFNC _{Cervical Cancer-Free North Carolina}

CDC Centers for Disease Control and Prevention

EHR _{Electronic Health Record}

ENCCC _{Eastern North Carolina Cancer Coalition}

FQHC Federally Qualified Health Center

HPV _{Human Papillomavirus}

IRB Institutional Review Board

KII Key Informant Interview

NC North Carolina

Pap test Papanicolaou test (earlier known as Pap smear)

REACH Racial and Ethnic Approaches to Community Health

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VI. INTRODUCTION

The Capstone Experience

The purpose of this summary report is to provide an overview of our Capstone project with Cervical

Cancer-Free North Carolina (CCFNC). Capstone is a fieldwork requirement of the Master of Public Health

(MPH) program in the Department of Health Behavior at the Gillings School for Global Public Health at the

University of North Carolina at Chapel Hill (UNC-CH). Capstone provides second-year MPH students the

opportunity to partner with a community organization to gain practical fieldwork experience in public health

through the completion of projects requested by the partner organization. The report begins with an

explanation of the benefits of stakeholder engagement, specifically qualitative research and community action

planning for improving cervical cancer prevention efforts. The report then discusses the methods used to

produce Capstone deliverables for CCFNC, followed by a results section that highlights key findings from the

project. The discussion section notes project implications for CCFNC and stakeholders, including project

limitations, recommendations, and considerations for sustainability of the overall project.

Cervical Cancer-Free North Carolina

CCFNC is a statewide coalition of government and community partners working together to

decrease cervical cancer incidence rates in the state (McCarthy, 2013). CCFNC’s office is in the Gillings

School of Global Public Health at UNC-CH. The organization conducts projects to improve cervical cancer

prevention through health systems and behavior changes. Since many health agencies in North Carolina (NC)

have roles in cervical cancer prevention, CCFNC encourages strategies that promote collaboration across

organizations to improve Papanicolau (Pap) testing and Human Papillomavirus vaccination (HPV) rates.

In 2013, CCFNC released a report, Cervical Cancer Prevention in North Carolina: Strengthening Health

Programs and Systems, that identified 30 counties in the state that have a high-need for cervical cancer

prevention (Figure 1) (McCarthy, 2013). High-need was determined by cervical cancer incidence and

mortality, screening rates among low-income women, and HPV vaccination rates. The report also outlined

evidence-based recommendations and strategies for healthcare providers to improve cervical cancer

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Figure 1: NC Counties with High Cervical Cancer Prevention Need (McCarthy, 2013)

In 2013, CCFNC requested a Capstone team to conduct qualitative research in some of the

high-need counties to better understand the challenges and opportunities that practitioners face in providing

cervical cancer prevention services. We, the CCFNC Capstone team, planned and conducted a regional

meeting in Fayetteville, NC based on information from the interviews. Meeting activities built upon

evidenced-based recommendations (hereinafter referred to as CCFNC’s recommendations) outlined in the

report by encouraging regional stakeholders to identify action steps that were feasible to tailor and implement

in their organizations to improve cervical cancer outcomes. In tandem with these efforts, our team updated

CCFNC’s online North Carolina Cervical Cancer Resource Directory, which contains information on

affordable cervical cancer screening locations throughout the state, and recommended strategies for

improving and promoting the Resource Directory.

Project Objectives and Deliverables

Our Capstone team identified two intended outcomes for the project: 1) stakeholder adoption of

recommendations for increasing cervical cancer prevention, and 2) increased stakeholder awareness and use

of the Resource Directory (see Appendix A). The long-term impact of our Capstone project is increased

cervical cancer screening of women who are rarely or never screening and increased HPV vaccination rates in

high-need counties in NC, both of which will contribute to a decreased incidence of cervical cancer and

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1. State summit proceedings report: Summary of NC Cervical Cancer Coalition Summit

2. Key informant interviews (KIIs) with community stakeholders in NC counties with high-need for cervical cancer prevention and analysis report

3. Regional meeting in South Central NC

4. Community Action Plan (CAP) report for South Central region 5. Updated online NC Cervical Cancer Resource Directory

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NC Cervical Cancer Resource Directory Survey and Promotional Recommendations Report We categorized deliverables one through four as stakeholder engagement designed to achieve the first

outcome outlined above. Deliverables five and six relate to NC Cervical Cancer Resource Directory Updates,

Improvements, and Promotion, which targeted the second outcome of our project.

VII. BACKGROUND

Cervical cancer is the second most common cancer among women worldwide (Documet et al.,

2008). However, unlike other forms of cancer, the physical, emotional, and economic impact of cervical

cancer is mostly preventable with routine Pap tests and uptake of the complete human papillomavirus (HPV)

vaccination series (Denslow, Knop, Klaus, Brewer, Rao, & Smith, 2012). In order to reduce the incidence and

mortality of cervical cancer in North Carolina, CCFNC works with stakeholder groups that are crucial to the

delivery and promotion of cervical cancer prevention and screening measures. These stakeholders include

administrators, decision-makers, and healthcare providers at county health departments, hospitals, private

practices, and community clinics. Additionally, health educators, school nurses, and organizations that engage

in cervical cancer prevention advocacy are important stakeholders to CCFNC. Collectively, these stakeholders

provide Pap tests, administer the HPV vaccine, and educate individuals about the importance of these

prevention practices.

To assist with CCFNC’s work, our team has been charged with engaging these stakeholders to

identify barriers and opportunities to improving the provision of cervical cancer prevention and screening

services in high-need regions of NC. The following section summarizes the current literature discussing the

use of stakeholder engagement to reduce the incidence and mortality rates of cervical cancer.

Epidemiological Assessment

HPV, the most common sexually transmitted infection, causes nearly all cases of cervical cancer and

if left untreated can be fatal (Garner, 2003; CDC, 2014). In the United States, cervical cancer causes more

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and 2007, there were 3,652 new cases of cervical cancer, or 8.2 cases per 100,000 women, and 1,208

associated deaths, or 2.6 cases per 100,000 women (Denslow et al., 2012). Cervical cancer affects adult

women at almost any age; in NC, the average age of diagnosis is 49 years old, with age at diagnosis ranging

from 19 to 98. Forty-five percent of cases occurred in 30-49 year olds, while more than half of mortality cases

occurred in women over the age of 50, as the risk of death increases with age (Denslow et al., 2012).

Minority, lower income, older, and recent immigrant women in NC have below average rates for

screening and HPV vaccine uptake, resulting in disproportionately higher cervical cancer incidences

(Documet et al., 2008). According to Denslow et al. (2012), Hispanic and Black women have higher incidence

rates (18.3 cases per 100,000 women and 10.6 cases per 100,000 women, respectively) than White women (7.3

cases per 100,000 women). Black women also have the highest mortality rate at 4.5 deaths per 100,000

women, which is greater than both the rates of non-Hispanic White and Hispanic women combined.

Minority status is associated with factors such as the lack of economic security and insurance coverage, which

in turn can result in lower utilization of cervical cancer prevention and screening services (Denslow et al.,

2012).

In addition to race, Denslow et al. (2012) found that cervical cancer burden varies by county in NC,

such that counties with lower economic prosperity have higher incidence and mortality rates than higher

income counties. This finding aligns with previous research demonstrating the association between poverty

and adverse health behaviors, in that the lower the income, the lower the rate of cancer screening (NC Center

for Health Statistics, 2008). The high-need counties are primarily located in the South Central and Northeast

regions of NC, as well as in the Western part of the state (Denslow et al., 2012). Engaging stakeholders in

counties with high cervical cancer prevention need to adopt evidence-based recommendations can improve

prevention efforts and reduce cervical cancer cases.

Approaches to Stakeholder Engagement

Involving stakeholders in cervical cancer prevention efforts is beneficial in multiple ways, due in part

to their knowledge of community culture, and may result in the improved sustainability of programs by

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specific barriers to care that underserved populations face. Their support and buy-in is crucial to the

implementation of evidenced-based recommendations proposed by outside organizations. According to the

National Cancer Institute, stakeholder collaboration can help improve the continuity of care of cervical

cancer services, decrease health system fragmentation, and facilitate a more efficient use of resources (Texas

Department of State Health Services, 2006). There is also a strong theoretical basis for facilitating

collaboration among organizations. One example is the Interorganizational Relations (IOR) Theory, which

presumes that “collaboration among community organizations leads to a more comprehensive, coordinated

approach to a complex issue than can be achieved by one organization” (Butterfoss, Kegler, & Francisco,

2008, p. 346). Collaboration with stakeholders can be accomplished through the processes of conducting

KIIs, hosting regional meetings, and developing CAPs. The decision to engage stakeholders through KIIs

and the development of CAPs is based on recommendations from the Diffusion of Innovations Theory

(Rogers, 2003). Given that the overall goal of our project is to promote the adoption of evidenced-based

strategies for increasing cervical cancer screening and HPV vaccination, the diffusion of innovations theory

offers a useful framework for understanding how organizations adopt new practices. The theory proposes

that organizations will adopt innovations at different stages and that properties of the innovation such as

relative advantage, compatibility, trialability, observability, and complexity influence this rate. Stakeholder

engagement helped our team assess the compatibility of cervical cancer prevention strategies with these

organizations and highlight their relative advantage.

Key Informant Interviews (KIIs)

KIIs are an important component for building stakeholder engagement in multiple regions, both

domestically and internationally, and are essential in reaching target populations (Allen et al., 2010). KIIs also

provide insight into stakeholders’, community members’, and clinicians’ perspectives of how community

structures impact the uptake of cervical cancer screenings and HPV vaccinations in underserved women and

hard to reach populations. In the literature, KIIs are used to involve stakeholders, increase buy-in, and gather

information needed to make decisions and recommendations about cervical cancer prevention services that

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Katz et al. (2007) and Documet et al. (2008) conducted interviews regarding Pap tests in 17 Ohio

Appalachia counties and eight Western Pennsylvania counties. The populations in these counties are

demographically similar to NC’s underserved female population. To examine the social, economic, and

healthcare environments that affect cervical cancer screening, researchers in both studies conducted KIIs

with residents, providers, and stakeholders using semi-structured interview guides. Study results revealed that

most of the women had limited knowledge of cervical cancer, limited access to healthcare services, and did

not receive recommended Pap test (Katz et al., 2007; Documet et al., 2008). These studies were effective in

increasing community engagement through KIIs, which helped inform strategies to increase recruiting and

retention methods for cervical cancer screening among target populations.

Although there is limited domestic research about the implementation and evaluation of HPV

vaccine programs, international data indicates that KIIs are effective in engaging the community and

stakeholders in creating HPV vaccination programs and policies. Leask et al. (2009) conducted 24

semi-structured KIIs with program managers and primary care providers to evaluate the early implementation of

Australia’s national HPV vaccination programs for females, ages 12-26 years old. A study in Uganda by

Katahoire et al. (2008) provided another example of how KIIs were successfully used for community

engagement surrounding HPV vaccine uptake. This study’s ultimate objective was to generate evidence for

governmental decision-making and operational planning for the introduction of HPV vaccine in the country.

Similar to the cervical cancer screening studies discussed previously, the information obtained from KIIs

revealed that HPV vaccination perspectives were effective in developing large stakeholder colloquiums and

building community engagement across regions regarding cervical cancer, which in turn can facilitate

collaborative efforts to implement evidence-based strategies to increase cervical cancer prevention services

(Katahoire et al., 2008; Leask et al., 2009).

Convening Regional Stakeholders

In addition to gaining insight on stakeholder perspectives through KIIs, an emerging method for

promoting engagement is the convening of regional stakeholders through meetings and symposiums. Sherris

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Asia that drew representatives from 20 nations. The conference conveyed the importance of cervical cancer

as a public health issue and improved cooperation among gynecological oncologists in the region (Sherris et

al., 2005). Furthermore, in 2011 the World Health Organization (WHO) hosted a regional meeting on cervical

cancer prevention in Europe; deliverables of the meeting included an overview of lessons learned on HPV

vaccination from countries that were early adopters and outlined future priorities for prevention (WHO

Regional Office for Europe, 2011). Domestically, the Texas Department of State Health Services and the

Texas Cancer Council worked with various stakeholders, including nurses, health educators, and researchers,

to develop the Texas Cervical Cancer Strategic Plan (Texas Department of State Health Services, 2006).

Several meetings, both in-person and via teleconference, facilitated this effort. Additionally, one of the

specific objectives listed in the Texas Cervical Cancer Strategic Plan was to increase the number of regional

and local cancer networks, to be achieved in part through engaging stakeholders to develop regional/local

coalitions. While the previous examples do not include measurable outcomes, we believe that convening

regional stakeholders can contribute to a growing commitment to improving cervical cancer prevention in

their area through the promotion of inter-organizational collaboration.

Community Action Plans

Similar to the Texas Cervical Cancer Strategic Plan, the development of a CAP is a localized

approach for identifying objectives and results from stakeholder engagement. Creating a relevant CAP is

facilitated by the stakeholder knowledge and inter-organizational collaboration gained from KIIs and regional

meetings, respectively. Several programs designed to address cervical cancer have employed this strategy. For

example, the Centers for Disease Control and Prevention’s (CDC) Racial and Ethnic Approaches to

Community Health (REACH) initiative includes a goal of reducing breast and cervical cancer disparities

(Fouad et al., 2004). The Alabama REACH 2010 Project, designed to reduce disparities between African

American and White women, involved three sequential stages: coalition building, community needs

assessment, and the development of a CAP. The coalition used information from the community needs

assessment to inform the development of individual, community systems, and change agent level objectives

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utilized similar methods to inform the development of its own CAP (Bigby, Ko, Johnson, David, & Ferrer,

2003).

A final example of community action planning is from 2000-2004 in Santa Clara County, California

among Vietnamese American women (Nguyen et al., 2006). Based on input from coalition members,

including the Vietnamese Physician Association of Northern California and the Santa Clara County Public

Health Department, the Vietnamese REACH for Health Initiative Coalition developed a six-component CAP

to increase Pap testing. Using Harris County, Texas as a comparison group, the quasi-experimental, pre-post

evaluation design revealed that although Pap test rates were comparable between the counties initially, Santa

Clara County experienced a significant increase in rates after the CAP activities were implemented (77.5% to

84.2%, p<0.001). This increase was not seen in the comparison group (73.9% to 70.6%, p=NS) (Nguyen et

al., 2006).

Our Approach

Based on the aforementioned evidence, our team used KIIs, regional meetings, and CAPs as ways to

engage and collaborate with stakeholders. The literature suggests that these methods are effective at

addressing and reducing cervical cancer disparities in vulnerable female populations similar to those in NC.

These methods align with CCFNC’s mission to improve cervical cancer screening rates and HPV vaccination

coverage in high-need counties of NC.

VIII. METHODS

Organization Orientation

In order to complete six deliverables for CCFNC, our team relied on several methodologies and

skills. First, our team held several meetings with mentors to become better oriented to CCFNC and its

mission, as well as to prepare for the State Summit that occurred in September 2013. During these meetings,

mentors provided a context for Capstone deliverables and detailed information on CCFNC’s purpose and

stakeholders. In addition, Dr. Jennifer Smith, an epidemiological expert in HPV and cervical cancer, provided

a presentation regarding cervical cancer pathology and HPV vaccine to our team to further our understanding

of this issue. Finally, we read the CCFNC report, Cervical Cancer Prevention in North Carolina: Strengthening Health

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regions in the state and recommended evidence-based actions for strengthening health programs, both of

which helped to inform our team’s work. Stakeholder engagement also informed our team’s work: in phase 1

we engaged with stakeholders to better understand their perspectives, while in phase 2 we focused on guiding

stakeholders through an action-planning framework.

Stakeholder Engagement – Phase 1

Following this orientation to CCFNC, our team prepared for the State Summit and created a note

taker form to summarize discussions at the meeting and a key informant interview guide to test at the

meeting. The note taker form helped organize field notes and allowed us to identify major themes discussed

by participants. We documented these findings in the Summary of NC Cervical Cancer Coalition Summit, which

highlighted recommendations prioritized by participants at the meeting and discussions surrounding the

recommendations. CCFNC disseminated the document through direct email to summit attendees, coalition

partners, an announcement in the monthly newsletter, and a posting to the CCFNC website.

After completing the pilot test and subsequent modifications to the KII guide, our team submitted

an application to the Institutional Review Board (IRB) and was approved to conduct KIIs. We identified and

recruited key informants (n=32) from the South Central and Northeast regions of the state by contacting

CCFNC stakeholders in high-need regions and asking informants for referrals. Our team contacted members

of the NC Cervical Cancer Coalition and other community members referred to us by interview participants,

via email and phone, to request participation in a 30-minute phone interview. Between October 2013 and

January 2014, our team conducted a total of 25 interviews with 32 individuals in South Central and Northeast

NC (see Appendix B and C). All interviews were conducted over the phone in pairs, with one Capstone

member leading the interview while the second took field notes. After completing all interviews in both

regions, we summarized interview notes and developed topical and sub-topical codes to categorize themes.

We analyzed the qualitative data using Atlas.ti software, first coding one interview together to ensure that we

agreed on what content applied to each code. We drafted two internal analysis reports (one per region) to

document major themes, challenges, and solutions identified from these interviews. The reports informed

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Stakeholder Engagement – Phase II

Event planning for the regional meeting also overlapped with the KIIs. First, our team and mentors

selected Fayetteville, in the South Central region of NC, and Rocky Mount, in the Northeast region, as

meeting locations because of their centrality, concentrated populations, and availability of venues. After

choosing these locations, team members identified, contacted, and visited potential venue locations. During

this time, mentors and team members became concerned with the feasibility of implementing two regional

meetings because of time constraints. After a discussion with the mentors, the meeting in South Central was

prioritized because of the area’s larger population, and it was decided that the meeting in the Northeast region

would be postponed. Once the meeting venue and date were finalized, our team developed an email

invitation and distribution list using the North Carolina Institute for Public Health (NCIPH) to handle the

online registration for the event.

Occurring simultaneously with event planning, content planning for the event involved several

meetings with mentors to develop the meeting agenda, to recruit and coordinate moderators and speakers,

and to create materials that facilitate the breakout session activities. These activities were informed by

CCFNC’s recommendations on how to prevent cervical cancer in NC and by information gathered from the

KIIs (McCarthy, 2013). Our team researched models for developing community action plans (CAPs) and

adapted the materials to facilitate community action planning activities for the breakout sessions from the

Community Tool Box from the University of Kansas (Community Tool Box, 2013). Specifically, we created

seven handouts for the meeting: an agenda, two recommendations handouts for the breakout sessions, a CAP

worksheet, an educational resources handout, a speaker bio sheet, and an evaluation form. Our team also

developed two presentations for the regional meeting. One presentation provided background information

on cervical cancer data specific to the South Central region, including relevant findings from the KIIs, while

the other shared the prioritized recommendations from the State Summit so that attendees would be familiar

with the recommendations prior to the breakout session. Finally, a map of the South Central region was

created to illustrate hospitals, cancer centers, Breast and Cervical Cancer Control Program (BCCCP) counties,

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During the regional meeting, a total of 41 participants from 19 organizations shared innovative ideas

through small and large group discussions, which facilitated the development of action plans. The meeting’s

breakout sessions, which focused on cervical cancer screening and HPV vaccination, provided attendees the

opportunity to think through the action steps necessary for strategy implementation (e.g. who needs to be

involved, approval process, timeframe). One moderator per breakout session facilitated the group discussion,

highlighting various strategies for achieving the selected CCFNC recommendations (McCarthy, 2013).

Participants recorded their strategies, action steps, and notes from the discussion on the handouts developed

by our team, most of which were then collected by us to inform the CAP Report.

The strategies and actions steps documented in the breakout session handouts were compiled into

the CAP Report, which served as a collaborative plan to help reduce cervical cancer in South Central NC. We

then drafted and finalized the report based on these worksheets, discussions that occurred at the regional

meeting, and feedback from the mentor and teaching team. CCFNC emailed the CAP Report to regional

meeting attendees to enable them to see the strategies that other stakeholders in their region identified as

feasible.

NC Cervical Cancer Resource Directory Updates, Improvements, and Promotion

Concurrent to stakeholder engagement, our team also updated the NC Cervical Cancer Resource

Directory. In collaboration with mentors, we determined what additional information would be helpful for

providers and women using the Resource Directory. Additional items included what languages the clinic

offered translation services for and whether clinic exam tables could accommodate women who were

overweight/obese, as such services may facilitate the screening of women rarely or never screened. Our team

then developed a phone survey and began calling each clinic listed in the directory. Additional information

was collected for approximately 30 clinics. We created a spreadsheet to document the information gained

from each conversation. Before each call, any information that was obtained from the clinic websites was

recorded in the spreadsheet and verified by phone. Our team also converted the phone survey into a

Qualtrics survey for clinics that preferred to answer the questions electronically. We completed edits to the

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While conducting KIIs and updating the Resource Directory, our team conducted formative research

for the Promotional Recommendations Report by developing an online survey in Qualtrics. First, our team

determined two objectives for the questionnaire: 1) to develop recommendations for making the Resource

Directory more useful to practitioners, and 2) to determine promotional strategies that could be used to

increase use of the Resource Directory. After our team and mentors provided feedback on multiple iterations

of the questionnaire, we emailed the survey to healthcare professionals (n=357) throughout NC with an

incentive to enter a drawing to win a $25 Amazon gift card.

For the Promotional Recommendations Report, we reviewed and analyzed the results of the

Qualtrics survey to develop strategies to increase awareness and use of the Resource Directory, based on

survey respondents’ suggestions. A total of 59 participants from 43 counties in NC, representing health

departments, primary care clinics, hospitals, insurance companies, academia, non-profit, and local and state

government agencies completed the Resource Directory survey. Using these data, we developed eight

promotional recommendations for CCFNC, some of which included email campaigns, social media messages,

Resource Directory promotion through links on partner organizations’ websites, and search engine

optimization. This report was finalized after feedback from the mentors and submitted to CCFNC for

internal use.

IX. RESULTS

The overall goals of this project were to: 1) promote and encourage the adoption of CCFNC’s

evidenced-based recommendations for increasing cervical cancer screening and HPV vaccine uptake rates and

2) to increase awareness and use of the NC Cervical Cancer Resource Directory. These outcomes will

decrease the incidence and mortality rates of cervical cancer in NC by increasing the number of people who

are screened and vaccinated. In the following section, we describe key findings across our project deliverables.

Engaging with Stakeholders to Encourage Participation and Build Support

Consistent and regular stakeholder engagement throughout the course of the project was essential to

foster stakeholder buy-in and inform project deliverables. Stakeholder engagement through KIIs and written

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challenges to providing cervical cancer prevention services included physician reluctance to recommend the

vaccine and health organizations’ limited capacity (e.g. funding, time, staff, equipment). Despite these

challenges, participants noted opportunities to improve cervical cancer prevention that included:a)

strengthening partnerships, b) using technology such as electronic medical records, c) providing additional

training and resources for staff, and d) increasing awareness of cervical cancer prevention services through

local media promotion and health education. These findings informed subsequent deliverables (regional

meeting and CAP Report).

Prioritizing and Adopting Evidenced-Based Strategies to Improve Cervical Cancer Prevention

At the statewide cervical cancer summit, participants prioritized two of CCFNC’s recommendations

to improve cervical cancer prevention: 1) encourage providers to recommend HPV vaccine and 2) improve

recruitment of women who are rarely or never screened. Months later at the regional meeting, participants

outlined specific strategies and action steps to implement these recommendations. For example, some

attendees of the meeting identified the strategy of using Electronic Health Records (EHRs) to: 1) remind

physicians to discuss HPV vaccination with patients or their parents or 2) identify rarely or never screened

women with the action step of programming alerts. Activities at the regional meeting provided stakeholders

with a framework for creating sustainable change within their organization. Assessing the actual

implementation of these strategies is beyond the scope of this project. Overwhelmingly, participants were

very satisfied with the regional meeting and agreed that the event succeeded in meeting the outlined

objectives (see Appendix D).

Improving and Promoting the Resource Directory to Increase Use

Our team identified a number of challenges that limit the use of the Resource Directory, namely

inaccurate listings, poor Spanish translation, and complicated language. Addressing these issues and revising

the layout has the potential to increase the usefulness of the tool. Recommendations for promoting the tool,

based on user suggestions and CCFNC resource considerations, include circulating information about the

directory through partner health and non-health organizations’ newsletters and listervs, using search engine

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have the potential to increase awareness and use of the Resource Directory among healthcare professionals

and women seeking free or low-cost screening services.

X. DISCUSSION

Implications for CCFNC

Our Capstone project built upon CCFNC’s recommendations to improve cervical cancer prevention

by facilitating efforts to implement these recommendations. More specifically, our team assisted in the

planning and execution of a regional meeting that can be replicated in other regions of the state. CCFNC can

use the format, worksheets, and activities developed by our team to plan future CAP meetings in other

high-need regions of the state, such as the Northeast and the West. Similarly, our interview guide and KII analysis

reports provide a framework for CCFNC to conduct similar research in other areas of the state. Procedures

and materials for updating the Resource Directory can be used periodically to verify the accuracy of records

in the directory going forward. Furthermore, the Resource Directory survey results and the Promotional

Recommendations Report identify areas for CCFNC to increase the functionality of the Resource Directory

and expand awareness and use of the Resource Directory through different promotional strategies.

Implications for Cervical Cancer Prevention

Our Capstone project contributed to a deeper understanding of the resources, challenges, and

opportunities to providing cervical cancer prevention services in the South Central and Northeast regions of

North Carolina. While the results of our Capstone project are not generalizable, our methods of stakeholder

engagement can be used in other regions to facilitate system-level changes. The regional meeting and CAP

Report encouraged local organizations working in cervical cancer to strategically implement the CCFNC

recommendations that align with their organizations’ goals and objectives by identifying feasible action steps

given their existing resources. If organizations implement intended action steps with fidelity, we expect that

screening and HPV vaccination rates will increase. The regional meeting was also an opportunity for

attendees to meet new colleagues involved in cervical cancer prevention work and identify potential

partnerships with other organizations serving the same community. In addition, our recommendations to

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Project Limitations

Our KIIs were crucial in planning the regional meeting to develop a CAP that is relevant to the

interests and needs regarding cervical cancer prevention in South Central NC. Continued stakeholder

engagement through additional interviews, in-person meetings, and county visits would have improved our

Capstone project. Supplementary interviews with key stakeholders and greater representation from different

types of healthcare professionals (e.g. health directors) would have enhanced our understanding of the

structural barriers to cervical cancer prevention. In our interviews, three of the eight high-need counties in the

South Central region and five of the 12 counties in the Northeast region were not represented in our

research. Broader representation from high-need counties would have contributed to an even deeper

understanding of local organizations’ resources, challenges, capacity, and opportunities to providing cervical

cancer prevention services. The breadth of our Capstone project meant we did not have enough time to build

relationships with key stakeholders or community leaders prior to the regional meeting. We also did not have

time to follow-up with South Central stakeholders with a second meeting or conference call, which could

have allowed for greater collaboration between organizations and enhanced the potential for sustainable

action by continuing the momentum generated at the regional meeting.

Recommended Next Steps

Our team recommends that CCFNC support the Eastern North Carolina Cancer Coalition

(ENCCC) in hosting a regional meeting in the Northeast region that focuses on community action planning

to implement CCFNC’s recommendations to improve cervical cancer prevention. CCFNC can use meeting

materials developed by our team to create a CAP toolkit that can be disseminated to organizations or

coalitions interested in developing CAPs for this purpose. We also suggest that CCFNC regularly update the

Resource Directory and implement our recommendations to improve the Resource Directory website. After

these improvement recommendations are implemented, we suggest that CCFNC or partner organizations

implement feasible strategies to promote the directory, as listed in our Promotional Recommendations

Report. We recommend that CCFNC also evaluate the reach of the promotional strategies that it implements

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Considerations for Sustainability

An important consideration throughout this project was that CCFNC was in its last year of funding

and had been scaling down its operations throughout our Capstone work. The Resource Directory will

continue to provide clinics and women with information about where to obtain affordable screening services.

Should CCFNC use the procedures our team developed for updating the directory regularly, it will ensure

that this resource remains a useful tool. In addition, the CAP Report provided stakeholders with tools to

discuss and identify new strategies for cervical cancer prevention. Furthermore, the regional meeting

generated momentum among local partners, such as the ENCCC, to engage with CCFNC in planning future

regional meetings for cervical cancer prevention. Please see Appendix B for recommendations for

sustainability by deliverable.

Professional Impact

Our team gained knowledge about cervical cancer, including the epidemiology, barriers, and

opportunities impacting provider efforts to prevent cervical cancer in NC. As we executed our Capstone

project, we gained many skills throughout the year that will be useful in our future public health work. The

KIIs improved our qualitative data collection and analysis skills. In organizing the regional meeting, we

improved skills related to: event planning, facilitating interactive breakout sessions, creating and delivering

effective presentations, and stakeholder engagement. We gained experience in questionnaire design and

analysis through the development of the Qualtrics survey that informed the Promotional Recommendations

Report. Through updating the online Resource Directory, we learned how to use WordPress, a web content

management tool. The project also afforded several opportunities to improve our report writing skills for

both internal and external documents.

As the scope of our deliverables and timelines changed, we learned that communication, flexibility,

and adaptability are crucial to a project’s success. A main challenge for us at the beginning of the year was

adapting to changes in organizational and project leadership. We learned how to accommodate different

management styles and advocate for clarity around project goals and expectations. Our ability to

communicate effectively as a team and to establish individual strengths, work styles, preferences, and

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strengthened our ability to communicate with CCFNC and stakeholders, which was key to managing a project

that had several moving pieces at once.

XI. CONCLUSION

Over the past year, we have been charged with engaging stakeholders and developing tools and

resources through a variety of means in order to improve the state's healthcare capacity to provide cervical

cancer prevention services and reduce the disease's overall incidence and mortality rates in high burden

regions of NC. As evident in the literature, collaborating with stakeholders is key to quality improvement and

the facilitation of such services. Conducting KIIs, convening regional meetings, and developing CAPs are

effective in fostering discussion and action steps to reaching cervical cancer prevention goals. CCFNC used

these methods to gain a thorough understanding of the regional cervical cancer prevention landscape and

bring stakeholders together. Lastly, with the updates to the Resource Directory and the development of the

Promotional Recommendations Report, we expect that more providers, patients, and community members

will access important information related to cervical cancer prevention services.

We hope that through our various efforts we make an impact on cervical cancer by helping to

increase the capacity of our stakeholder groups to provide cervical cancer prevention services. Only together

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XII. REFERENCES

American Cancer Society. (2011). Cancer facts and figures. No. 500811.

www.cancer.org/acs/.../acspc-029771.pdf. Published in 2011. Accessed October 2013.

Agurto, I., Arrossi, S., White, S., Coffey, P., Dzuba, I., Bingham, A., Bradley, J., & Lewis, R. (2005).

Involving the community in cervical cancer prevention programs. International Journal of Gynecology and

Obstetrics, 89, S38—S45. doi:10.1016/j.ijgo.2005.01.015

Allen, M. L., Culhane‐Pera, K. A., Pergament, S. L., & Call, K. T. (2010). Facilitating research faculty

participation in CBPR: development of a model based on key informant interviews. Clinical and

translational science, 3(5), 233-238.

Bigby, J., Ko, L.K., Johnson, N., David, M. M. A., & Ferrer, B. (2003). A community approach to

addressing excess breast and cervical cancer mortality among women of African descent in Boston.

Public Health Reports, 118, 338-347.

Butterfoss, F.D., Kegler, M.C., & Fransisco, V. T. (2008). Mobilizing organizations for health promotion:

Theories of organizational change. In Glanz, K., Rimer, B. K., & Viswanath, K. (Eds.), Health behavior

and health education: Theory, research, and practice. San Francisco: Jossey-Bass.

Centers for Disease Control and Prevention. (2014). Genital HPV infection – fact sheet. Retrieved from

http://www.cdc.gov/std/hpv/stdfact-hpv.htm

Community Tool Box (2013). Developing an action plan. Retrieved from

http://ctb.ku.edu/en/table-of-contents/structure/strategic-planning/develop-action-plans/main

Denslow, S.A., Knop, G., Klaus, C., Brewer, N.T., Rao, C., & Smith, J.S. (2012). Burden of invasive

cervical cancer in North Carolina. Preventive Medicine, 54, 270-276.

Documet, P., Green, H., Adams, J., Weil, L., Stockdale, J., Hyseni, Y. (2008) Perspectives of African

American, Amish, Appalachian and Latina Women on Breast and Cervical Cancer Screening:

Implications for Cultural Competence. Journal of Health Care Poor Underserved, 19(1), 56-74. doi:

Fouad, M. N., Nagy, M. C., Johnson, R.E., Wynn, T. A., Partridge, E. E., & Dignan, M. (2004). The

development of a community action plan to reduce breast and cervical cancer disparities between

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Garner, E. I. (2003). Cervical cancer: Disparities in screening, treatment, and survival. Cancer

Epidemiology, Biomarkers & Prevention,12, 242-274s.

Katahoire, R. A., Jitta, J., Kivumbi, G., Murokora, D., Arube, W. J., Siu, G., Arinaitwe, L., Bingham, A.,

Mugisha, E., Tsu, V. (2008) An assessment of the readiness for introduction of the HPV vaccine in

Uganda. African Journal of Reproductive Health. 12 ( 3),

Katz, M. L. (2007). Key Informants' Perspectives Prior to Beginning a Cervical Cancer Study in Ohio

Appalachia. Qualitative Health Research., 17 (1), 131-141.

Leask, J., Jackson, C., Trevena, L., McCaffery, K., Brotherton, J. (2009). Implementation of the

Australian HPV vaccination program for adult women: Qualitative key informant interviews. Vaccine,

27(40), 5505, 5505-5512

McCarthy, S. H. (2013). Cervical cancer prevention in North Carolina: Strengthening health programs and

systems. Retrieved from

http://www.cervicalcancerfreecoalition.org/wp-content/uploads/Cervical-Cancer-Prevention-in-NC-Strengthening-Health-Programs-and-Syste....pdf

North Carolina Center for Health Statistics. (2008). Cancer in North Carolina. 2008 Report:

Cancer and income with a special report on cancer, income, and racial differences.

http://ucrf.unc.edu/publications/cancer_report_2008.pdf.

Nguyen, T., McPhee, S., Bui-Tong, N., Luong, T., Ha-Iaconis, T., Nguyen, T., Lam,

H. (2006). Community-based participatory research increases cervical cancer screening among

Vietnamese-Americans. Journal of Health Care for the Poor and Underserved, 17, 31–54. DOI:

10.1353/hpu.2006.0078

Rogers, M. (2003). Knowledge, technological catch-up and economic growth. Edward Elgar Publishing.

Texas Department of State Health Services (2006). Texas Cervical Cancer Strategic Plan. Retrieved from

https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&ved=0CCoQ

FjAA&url=http%3A%2F%2Fwww.dshs.state.tx.us%2Fbcccs%2FPDF%2Fcervical-cancer-strategic-plan.pdf&ei=PZVwUs6THNPHsASYu4C4Bw&usg=AFQjCNETO2Rz_M3SAgbtXmKf0bWehnZ

TYg&sig2=ZxJqgDRpfKNDqf06JKmHJQ

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(2005). Advocating for cervical cancer prevention. International Journal of Gynecology and Obstetrics, 89,

S46—S54. doi:10.1016/j.ijgo.2005.01.010

WHO Regional Office for Europe (September 12, 2011). Scope and purpose. Retrieved from

http://www.euro.who.int/__data/assets/pdf_file/0018/152235/Cancer_mtg_scope_and_purpose.p

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XIII. APPENDIX A: LOGIC MODEL

Figure 1: CCFNC Capstone Logic Model

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XIV. APPENDIX B: CCFNC Capstone Deliverables

Deliverable 1: Statewide Summit Meeting Materials & Summary of Proceedings

Format: Meeting minutes, 3-4 page report, and 1 page executive summary.

Purpose: To engage and support NC coalition partners and community stakeholder groups (e.g.

NC County Health Directors) in considering enhanced strategic and sustainable action against cervical cancer that is consistent with their organizations’ public health mission and easily integrated into their current program operations.

Intended Audience(s): NC County Health Directors and other health department employees, immunization

staff, pharmaceutical companies’ representatives, medical professionals, CCFNC coalition members, and health educators throughout the state.

Activities: 1. Review CCFNC’s status and policy report on the state of cervical cancer

prevention in North Carolina

2. Develop note taking form for summit proceedings

a. Review note taking forms from other conferences

b. Draft note taking form for summit

c. Finalize note taking form

3. Attend the statewide summit, take notes on proceedings

4. Write summary of statewide summit proceedings to inform participants and

community stakeholders of meeting recommendations, action steps, and key commitments

a. Compile meeting notes

b. Draft summary of proceedings

c. Finalize summary of proceedings

Recommendations for

CCFNC: _ Continue to disseminate Summit Proceedings Report to stakeholders _{Post the report on the Cervical Cancer-Free Coalition website}  Reference and distribute report whenever representatives attend an event

Deliverable 2. Key Informant Interviews (KIIs) with Community Stakeholders in Areas of NC with a High Cervical Cancer Prevention Need (Northeast & South Central Regions)

Format: (1) 6-8 question Interview guide; (2) 30-60 interviews by phone or in-person; (3)

Compiled interview case notes report to inform regional meetings; (4) 1-2 page report outlining the key themes from interviews per high-need region

Purpose: To identify needs, resources, capacity (e.g. funding, staff, organizational capacity, current

services offered), and barriers (e.g. transportation, language barriers, insurance status) to providing cervical cancer prevention services for organizations and individuals in high-need regions.

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Activities: 1. Submit IRB-exemption application for KIIs

2. Develop KII guide

a. Draft research and interview questions for ~30-45 minute interviews b. Pilot interview guide at Statewide Summit Meeting

c. Revise interview guide d. Finalize interview guide 3. Identify and recruit KII participants

a. Use existing CCFNC directory of community stakeholders to compile

a list of interview informants to be recruited (purposive and snowball sampling)

b. Consult with mentor team to identify additional key thought leaders in the field

c. Contact key informants via email and phone to participate in interviews

d. Schedule interviews with key informants

4. Conduct 30-60 (or until saturation) KIIs (both phone and in-person) in pairs using case notes method

5. Analyze KII findings and write a 1-2 page KII report of analysis per region a. Review case notes regular to identify emerging themes and new

questions to ask respondents

b. Develop codebook of topical and overarching themes

c. Code interview notes and create summaries

d. Draft a 1-2 page KII report (summary of themes and issues) for South Central Region

e. Draft a 1-2 page KII report (summary of themes and issues) for Northeast Region

f. Submit final KII reports for South Central and Northeast regions Recommendations for

CCFNC:  Use the report to inform future regional meetings in the South Central or Northeast regions

 Use the report to inform or identify areas for additional research in high-need regions

Deliverable 3: Updated Online Resource Directory

Format: Web-based resource directory

Purpose: To update this online directory so that it accurately reflects the latest community partner

and clinic information, as well as up-to-date cervical cancer screening guidelines around HPV co-testing.

Intended Audience(s): Medical and social service providers, as well as women ages 25-70 who are rarely

screened for cervical cancer (more than 3 years since the last pap smear), uninsured or under-insured women ages 21-70 in need of information about and locations for pap smears, and uninsured or under-insured adolescents aged 11-18 years of age who have not completed HPV dose administration in North Carolina.

Activities: 1. Update online Resource Directory

a. Create spreadsheet to track changes made to the directory. b. Update clinic information on spreadsheet

i. Create phone survey

ii. Call clinics to confirm information and inquire about transportation, accommodations for obese women, translation services, etc. iii. Adapt phone survey into a Qualtrics survey to be sent to clinics that

prefer to communicate information electronically iv. Distribute survey to those clinics that request it

2. Add material about new cervical cancer screening guidelines that include HPV co-testing

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site with the new screening guidelines

b. Propose the language and location of a link from the screening page to another webpage to explain the new guidelines

c. Finalize website language and send to CCFNC

Recommendations:  Use developed process to update Resource Directory annually

 Review and update content on website annually

Deliverable 4. South Central Regional Meeting

Format: Meeting in a high-need region of the state (Fayetteville, NC), electronic invitations for

meeting, meeting agenda, Excel list of attendees, and narrative synthesis of meeting proceedings with action steps. 25-40 people attending the regional meeting (3-4 hours)

Purpose: Work with community stakeholders to create a community action plan to facilitate the

implementation of recommendations listed in the Cervical Cancer Prevention in North Carolina: Strengthening Health Programs and Systems report.

staff, medical professionals, CCFNC coalition members, and health educators from South Central region.

Activities: 1. Plan regional meeting logistics

a. In consultation with preceptor and key informants, identify meeting dates and locations

i. Create a mileage and driving chart for potential regional meeting areas and locations

b. Develop final budget for regional meeting and send to preceptor for review

c. Secure meeting logistics

i. Identify and contact potential venue locations availability, capability, and prices

ii. Visit potential venues to assess space

iii. Coordinate with venue contact to develop Event order

iv. Finalize and sign event order and submit to UNC accounting for payment

d. Coordinate with North Carolina Institute for Public Health (NCIPH) to handle registration

i. Draft and finalize scope of work for registration tasks and submit to NCIPH

ii. Submit registration materials (Names, email addresses of invitees, invitation text) to NCIPH

2. Develop regional meeting materials

a. Draft meeting materials for the regional meeting, including:

i. Meeting agenda outline

 Identify and confirm speakers

ii. CCFNC recommendation handout

iii. Community action plan template/worksheets

iv. Map showing counties with BCCCP, Medicaid providers,

hospitals, and cancer centers from South Central Region

v. Speaker bios

vi. Meeting evaluation form

b. Finalize meeting materials and submit to NCIPH and create meeting

folders for attendees

3. Convene South Central Regional Meeting

a. Present factual information about cervical cancer in South Central region from KIIs and CCFNC research and solicit feedback from attendees on how to strengthen community resources

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and sustainable activities that could be implemented within their organizations

c. Present information about new Breast and Cervical Cancer Control

Program (BCCCP) guidelines

d. Identify action steps that stakeholders can build into their current program plans using a minimal investment of financial or staff resources

e. Take meeting notes

CCFNC:  Identify a partner organization such as the Eastern North Carolina Cancer Coalition and encourage them to organize a regional meeting in the Northeast region

 Share meeting materials to facilitate future meetings in different locations

Deliverable 5. South Central Region Community Action Plan (CAP) Report

Format: NarrativeReport (1 page executive summary + 3 page discussion, combined with

deliverable 4)

Purpose: 1. To summarize meeting proceedings and action steps to implement cervical

cancer prevention strategies

2. To make appropriate recommendations for stakeholder action and next steps

Intended Audience(s): Attendees of the regional meeting and CCFNC

Activities: 1. Create an outline for the CAP Report

a. Draft outline

b. Discuss in working meeting with mentors

c. Finalize outline

2. Write CAP Report

a. Send first draft to mentors

b. Incorporate mentor feedback and send second draft to mentors

c. Submit final CAP report to CCFNC for dissemination

CCFNC:  Follow-up with attendees via email; invite them to share their thoughts about the CAP report and progress in implementing strategies and actions steps

 Include attendees’ responses in CCFNC newsletter

Deliverable 6. NC Cervical Cancer Resource Directory Promotional Recommendations Report

Format: Internal document (1-2 pages) outlining recommendations for objectives, target

audience, activities, and timeline.

Purpose: To recommend strategies to improve, widely disseminate, and encourage usage of the

NC Cervical Cancer Resource Directory

Intended Audience(s): CCFNC

Activities: 1. Conduct formative research for communication and outreach

a. Design 5-10 minute online survey to assess awareness of resource directory, improvements that can be made, and promotional strategies (e.g., media outlet identification)

b. Create and test Qualtrics survey

c. Disseminate survey to CCFNC coalition members and other

stakeholder groups

d. Send reminder email about survey

e. Close survey

2. Write Communication and Outreach Recommendations Report

a. Review and analyze results from survey to help inform communication and outreach recommendations and to inform updates to the resource directory

b. Outline communication and recommendations report

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send to mentors

d. Incorporate feedback from mentors and finalize report 3. Finalize and submit communication and outreach recommendations report Recommendations for

CCFNC: _ Implement website improvements from the report _{Select and implement at least one method for promoting the Resource}

Directory from the report

 Consider how to evaluate the effectiveness and reach of promotion method(s)

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XV. APPENDIX C: KII Participants

Table 2: South Central KII Participants by County

County Organization (# of participants)

Anson Health department (1)

Cumberland Health department (3)

Harnett Health department (1)

Robeson Health department (2); Southeastern Regional Medical Center (1)

Scotland Health department (1)

Regional BCCCP (5), American Cancer Society (2), NCDPH (1)

Table 3: Northeast KII Participants by County

County Organization (# of participants)

Edgecombe Health Department (2)

Halifax Gregory B. Davis Foundation (3); Rural Health Group (1)

Martin- Tyrell-

Washington Health Department (2)

Nash Health Department (2)

Pitt Pitt Public Health Center (1); East Carolina University (1)

Warren Health Department (2)

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XVI. APPENDIX D: Regional Meeting Attendance and Participant Evaluation

Table 4: South Central Regional Meeting Attendance by Organization

Organization Number Organization Number

Cumberland Co Health Dept 10 Robeson Co Health Dept 2

American Cancer Society 3 Wade Family Medical Center 2

Carolina Collaborative Community Care 2 Beaufort Co Health Dept 1

DHHS DPH 2 Cape Fear Valley Health System 1

East Carolina University 2 Community Care for Sandhills 1

Harnett Co Health Dept 2 Duplin Co Health Dept 1

Merck & Co Inc 2 Robeson Co Health Dept 1

NC BCCCP 2 Robeson Health Care Corporation 1

North Carolina Central University 2 WAMC Adolescent Clinic 1

Planned Parenthood of Central NC 2 Womack Army Medical Center 1

Table 5: South Central Regional Meeting Attendance by County

County Number

Beaufort 1

Cumberland 20

Duplin 1

Durham 2

Harnett 3

Pitt 2

Robeson 4

Scotland 1

Wake 3

Non-county 4

Table 6: Participant Satisfaction with Regional Meeting (n=36)

satisfied Not Somewhat satisfied Satisfied satisfied Very N/A

Handling of registration 0 0 3 33 0

Meeting rooms 0 6 13 17 0

Presentation: CC in SC NC 0 1 7 28 0

Presentation: Evidenced Based Action 0 1 8 27 0

Breakout sessions 0 0 5 31 0

Networking opportunities 0 0 5 29 2

Packet materials 0 0 10 25 1

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Table 7: Participant Assessment of Meeting Utility (n=31)

Strongly disagree Disagree Agree Strongly agree

I'm glad we met in person 0 1 6 24

This meeting changed the way I think about cervical cancer

prevention 0 2 17 12

This meeting will help me improve my organization's approach to